The Biggest Donation

Jonah Salz ’78 was grappling with end-stage kidney disease, facing 12 hours of dialysis a week and a long wait for a donor kidney. Then classmate Rick Rybeck stepped forward and changed his life.

In April of 2016, Jonah Salz ’78 clicked on an extraordinary email from a Haverford classmate as he sat in the waiting room of the Mayo Clinic’s Kidney Transplant Program. “I don’t know if you’re still in the market for a donor kidney, but I’m ready to volunteer,” wrote Rick Rybeck ’78. “Let’s talk.”

Salz, a professor of comparative theater at Japan’s Ryukoku University who’s lived in Kyoto for more than 30 years, had end-stage kidney disease. He’d returned to the United States to add his name to regional transplant waiting lists and to begin dialysis—a blood-filtering process that would take four hours a day, three days a week, every week. “I was thrilled by Rick’s generous email, but I knew it was a long shot,” says Salz, now 62. “I had given up on finding a living donor—none of my relatives or close friends was a match. I hadn’t reached out to a wider circle of people, so I was surprised and cautiously optimistic.”

Rybeck, 62, a Washington, D.C., attorney who works in sustainable urban redevelopment, had barely known Salz at Haverford. The two are very distant relatives: “Jonah is the half-brother of my mother’s first cousin’s son’s wife,” he explains. Their only shared memory from Haverford: Rybeck once performed a bawdy routine Salz wrote for Class Night (a now-defunct tradition in which students presented skits and songs).

Almost by accident, he learned of Salz’s illness in early 2016 after a neighbor with a theater background visited Salz in Japan. “I thought donating a kidney was a great opportunity to do something that would be truly helpful,” Rybeck says. “I’ve known a number of people on dialysis. It’s a very rough process. If I could save Jonah from that, it would be a good thing. At the very least, I would learn a lot about my health as they tested me as a potential donor.”

Over the next 13 months and against steep odds, blood tests showed that Rybeck was a good match. They shared a blood type: A+. Their tissue type was similar enough that the risk for organ rejection was deemed low. Rybeck’s cells were also periodically mixed with Salz’s blood to look for warning signs of rejection. There were none. But there were bumps, too. “My family was very worried about the procedure,” Rybeck says. Salz says that made him feel guilty, though he understood that the decision was Rybeck’s. At one point, Rybeck learned he’s among the 10 percent of Americans with latent, asymptomatic tuberculosis. “We thought that was the end,” Salz says. Instead, doctors gave Salz extra medication in the months before the transplant and decided it was OK to proceed.

Still, Salz’s doctors recommended he keep his name on waiting lists for a deceased-donor kidney—a list that in 2016 included more than 100,000 people with a waiting time of about 3½ years, according to the National Kidney Foundation. Without a kidney transplant, Salz faced a lifetime of dialysis. But both men hoped the living-donor transplant would work; 97 percent are fully functional right after the procedure, compared to 50-to-60 percent of deceased-donor kidneys. Long-term chances of rejection are also lower with living-donor transplants. “I tend to keep a Zen sense of calm about things,” Salz says. “The transplant could have been called off at any moment. Tests for compatibility continue up until the procedure. And a donor can change their mind at any time.”

Rybeck never changed his. On May 22, 2017, he and his wife spent the night near Johns Hopkins Medical Center in Baltimore with Salz and his sister. “It’s not like we went out for a big celebratory meal or stayed up late. We were on a clear liquid diet before surgery and had to go to bed early,” Salz says. At 5 o’clock the next morning they walked to the hospital together, hugged, and headed to separate pre-op areas. A few hours later, surgeons removed Rybeck’s left kidney and attached it to Salz’s bladder and blood vessels. “It appeared to go fine,” Rybeck says. “Afterward, the doctor said I had a beautiful kidney. I said, ‘I bet you say that to all your patients.’ ”

Yet both men experienced complications. “Surgeons typically leave a recipient’s kidneys in place during a transplant; the idea is even if they’re working at just 5 percent of capacity, they’re doing something,” Salz explains. “But I had four serious infections in the months after the transplant. My kidneys were removed in May of 2018, and I’m recovering. The good news is that I have not needed dialysis since the transplant. Rick’s kidney works great. I have more energy and can eat what I want—but I’m very careful. I don’t want to hurt Rick’s kidney.” Salz will take immune-suppressing anti-rejection medication for life.

Rybeck remained in the hospital for three and a half weeks after the transplant with intestinal blockages that required two additional surgeries and left him eating little more than ice chips for about two weeks. He lost 30 pounds. “I’ve recovered. I’m just about back to normal,” he reported this fall.

The two men now share a deep bond, despite taking very different paths after Haverford. Salz, who studied British literature and drama at Haverford, fell in love with traditional Japanese theater and ritual while teaching English in Japan in 1980. It’s been his home—with a few returns to the United States for graduate school and teaching stints—ever since. Editor of A History of Japanese Theatre (Cambridge University Press, 2016), Salz has pioneered intercultural performances that deploy techniques of kabuki, noh, and a comedy form called kyogen to interpret the works of Shakespeare, Samuel Beckett, and others. Salz also founded a summer program in Kyoto in traditional Japanese theater for actors from around the world. Salz and his wife have one daughter.

Rybeck, who studied economics and sociology at Haverford and has a law degree, founded Just Economics, LLC, in 2009. The company assists communities in promoting job creation, affordable housing, transportation efficiency, and sustainable economic development. As a former official in the Washington, D.C., Department of Transportation, he once made headlines with a plan that boosted the price of on-street parking around Washington Nationals Park on game days—nudging fans to take public transportation and freeing spots for local residents and businesses. Rybeck and his wife live in Washington.

Salz spent a recent birthday with Rybeck and his wife and parents. The two stay in touch online, and when Salz returned to Johns Hopkins for follow-ups recently, they toured Washington museums together. Rybeck has an open invitation to visit Salz in Japan, too.

“We’re really family now,” Salz says. “Rick’s altruism is very inspiring. After he left the hospital, he stopped by my apartment to thank me for giving him the opportunity to do some good. He’s really my hero.”